Should You Use Vaginal Estrogen After Menopause?

Many women use vaginal estrogen products to treat symptoms of menopause, and wonder if they should continue post-menopause.

Photo by Sasun Bughdaryan on Unsplash

Vaginal estrogen can treat many pesky menopause symptoms, like dryness and pain. It can also help decrease the incidence of urinary tract infections. Many women begin to use these products several years before their last menstrual period, since perimenopause can cause similar symptoms.

Vaginal estrogen comes in many shapes and forms: rings, creams, and tablets, which are inserted directly into the vagina. Since the Food and Drug Administration removed a black box warning from estrogen products last year - including vaginal estrogen - many more women have been seeking them out. (Previously, those warnings included an increase risk of cancer and blood clots.)

That, along with the increasing awareness and open discussion of menopause, has put the power back in women’s hands (literally and figuratively) to manage their menopause symptoms.

Below, some important facts to know:

Vaginal estrogen treats a group of symptoms that make up G.S.M., or genitourinary syndrome. That’s a medical term for what was previously called vaginal atrophy or atrophic vaginitis. The common symptoms include vaginal changes (dryness, burning, itching, and tissue thinning), pain or bleeding during and after sex (caused by decreased lubrication) or frequent bladder infections.

To make things worse, urination can become painful, more urgent and frequent, and tender vaginal tissues can actually tear or bleed with everyday activities.

Estrogen, once again, is the main culprit here. When it drops, it cannot efficiently do it’s former job of keeping your vaginal tissues thick, stretchy and moist.

According to research, G.S.M. does not affect every single woman; some lucky ones pass through menopause without any symptoms. But, as you might know from talking to your friends - or if they’re not open or would rather not talk about it, just look at the literature - it is a pretty common condition and complaint.

Left untreated, it won’t get better, but will certainly worsen over time. The vaginal tissue progressively thins, sexual discomfort increases, and the incidence of urinary tract infections can climb.

While this might not sound too dangerous, it can be: repeated urinary tract infections (UTIs) have the potential to spread to your kidneys, and can even lead to dangerous conditions like urosepsis (a life-threatening medical emergency when the UTI spreads to your kidneys and enters your bloodstream).

Many experts agree that G.S.M. is undertreated due to going undiagnosed or failure of healthcare providers to offer a prescription for vaginal estrogen. Also, many women may be hesitant to discuss it, or may think it’s not significant enough a problem to necessitate treatment.

Other women may fear hormones, but it’s important to know that:

a). Very small doses are commonly prescribed, and

b). Very little estrogen gets absorbed into the bloodstream (most stays within the vaginal tissue).

Still others may worry about safety if they’ve had an estrogen-sensitive cancer, but it’s reported that most women who have completed treatment can use vaginal estrogen. However, they may opt to use a tablet or ring rather than cream, so that the the dosage can be more precisely controlled.

It’s best not to wait until your symptoms get so uncomfortable, but instead to start using vaginal estrogen at the first, mild signs of a problem.

And finally, it’s important to have an open discussion with your healthcare provider and reach a decision together. If you don’t want to use vaginal estrogen, here are some alternatives from the Mayo Clinic.

Thanks for reading AfterthePause. Hope you stay healthy, wellthy and pain-free!

And while you’re here, feel free to leave a comment or share any thoughts or suggestions below.

The information provided on the site is for educational purposes only, and does not substitute for professional medical advice, diagnosis or treat

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